@article{ref1,
title="Improvement on the Coma Recovery Scale-Revised during the first four weeks of hospital stay predicts outcome at discharge in intensive rehabilitation after severe brain injury",
journal="Archives of physical medicine and rehabilitation",
year="2018",
author="Portaccio, Emilio and Morrocchesi, Azzurra and Romoli, Anna Maria and Hakiki, Bahia and Taglioli, Maria Pia and Lippi, Elena and Di Renzone, Martina and Grippo, Antonello and Macchi, Claudio",
volume="99",
number="5",
pages="914-919",
abstract="OBJECTIVES: to evaluate the prognostic utility of serial assessment on the Coma Recovery Scale-Revised (CRS-R) during the first 4 weeks of intensive rehabilitation in patients surviving from severe brain injury DESIGN: prospective cohort study PARTICIPANTS: Patients consecutively admitted to the Intensive Rehabilitation Unit at the IRCCS Don Gnocchi Foundation (Florence, Italy). Inclusion criteria were diagnosis of unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) due to acquired brain injury, age older than 18 years. INTERVENTIONS: All the patients underwent clinical evaluations using the Italian version of the CRS-R during the first month of hospital stay. MAIN OUTCOME MEASURES: behavioral classification on the CRS-R and score on the Glasgow Outcome Scale (GOS) at final discharge. Patients transitioning from UWS to MCS or emergence from MCS (E-MCS) and from MCS to E-MCS were classified as patients with improved responsiveness (IR). <br><br>RESULTS: After a mean hospital stay of 5.3 + 2.7 months, 59 out of 110 patients (53.6%) of the patients achieved an IR. In the multivariable analysis, higher CRS-R score change at week 4 (OR 1.99; 95%CI 1.49-2.66; p<0.001) was the only significant predictor of IR at discharge. Fifty-three patients (48.2%) were classified as severely impaired at discharge (GOS=3). In the multivariable analysis, higher GOS scores were related to higher CRS-R score at admission (B=0.051; 95%CI 0.027-0.074; p<0.001), higher CRS-R score change at week 4 (B=0.087; 95%CI 0.064-0.110; p<0.001), and absence of severe infections (B= -0.477; 95%CI -0.778/-0.176; p=0.002). <br><br>CONCLUSIONS: An improvement on the total CRS-R score and on different subscales across the first four weeks of inpatient rehabilitation discriminates patients who will encounter a better outcome at discharge, providing information for rehabilitation planning and communication with patients and their caregivers.<br><br>Copyright © 2018. Published by Elsevier Inc.<p /> <p>Language: en</p>",
language="en",
issn="0003-9993",
doi="10.1016/j.apmr.2018.01.015",
url="http://dx.doi.org/10.1016/j.apmr.2018.01.015"
}